Advanced Abdominal Exam

Question 1

Assessment for rebound tenderness

Answer 1

Press into abdominal area. Examine for pain on release of pressure as opposed to application of pressure.

If pain is felt on release, rebound tenderness is present

Question 2

Assessment for guarding and rigidity

Answer 2

Guarding is voluntary contraction of the abdominal wall musculature. Rigidity is involuntary contraction.

There are two ways to dinstinguish:

1. Repeat testing. Guarding, but not rigidity, tends to diminish.
2. Distraction of the patient during exam similarly diminishes guarding, but not rigidity.

Question 3

Cough test

Answer 3

Ask the supine patient to cough. If the cough produces pain in the abdomen, it is likely the result of peritonitis. Pain may be reported by the patient or observed in flinching, grimacing, or moving of hands toward the abdomen.

Question 4

Murphy’s sign

Answer 4

To detect cholecystitis.

The clinician hooks their fingers just underneath the right costal arch below the hepatic margin and asks the patient to take a deep breath in. Inspiration will suddenly cease, as though it was switched off, when the lungs begin to push the gall bladder towards the physician’s fingers.

Quite sensitive and specific. A pretty decent diagnostic physical exam test.